Oral cobalamin for pernicious anemia

Article Abstract:

Anemia is a condition in which there is a decrease in the number of circulating red blood cells. Pernicious anemia is a chronic form of this blood disorder, characterized by the presence of macrocytes, or abnormally large red blood cells, and the absence of hydrochloric acid in the stomach. This blood disorder commonly occurs in 40- to 80-year-old Europeans of fair complexion, but has been reported in other races and ethnic groups, although the disease rarely develops in Asians and blacks. Pernicious anemia is associated with weakness, sore tongue, tingling and numbness of the extremities, gastrointestinal symptoms, and in severe cases, signs of heart failure. The disease is caused by the failure of the stomach to secrete enough intrinsic factor to permit the absorption by the intestine of vitamin B12, the extrinsic factor. This results from the wasting away of the glandular mucosa of the fundus portion of the stomach, and is associated with the absence of hydrochloric acid. Pernicious anemia is treated with cobalamin, a chemical that contains cobalt and also is contained in several B12 vitamins. Treatment with injectable forms of cobalamin are painful and difficult for patients who are elderly or living alone. Therefore, oral preparations were developed and have been shown to be effective when given in large doses, such as 300 to 1,000 micrograms daily. Oral cobalamin has not been popular in the US because of concerns regarding unpredictable absorption, patient compliance, and cost. However, current studies show that effective amounts of cobalamin are absorbed when sufficiently large doses are taken orally. In addition, patient compliance is better with oral cobalamin than with injectable forms of cobalamin. Currents costs of oral cobalamin have also decreased. Hence, a greater awareness of the effectiveness and availability of oral cobalamin treatment may be valuable to American physicians and their patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Dosage and administration, Pernicious anemia, Vitamin B12, editorial

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Aplastic anemia associated with canthaxanthin ingested for 'tanning' purposes

Article Abstract:

The case history is presented of a 20-year-old woman who took 'tanning pills' of canthaxanthin, a substance recommended by tanning parlors that colors the skin. Four months later, she was hospitalized for fatigue, headaches, easy bruising, and weight loss. She was found to have aplastic anemia, a condition in which the number of red blood cells drops precipitously as a result of suppression of bone marrow function. Since the patient was a Jehovah's witness, blood products could not be administered, and treatment consisted primarily of medication. After 15 days of hospitalization, the patient was discharged to her home for terminal care and died there two days later. Canthaxanthin is a substance added to animal feed to make chicken skin, egg yolks, and rainbow trout flesh appear more appetizing. When taken to promote tanning, it is deposited in the outer layer of skin and the fat just underneath that layer. Several side effects are associated with its use, and the Food and Drug Administration has warned that canthaxanthin should not be used as a tanning agent. However, it is advertised and recommended by commercial tanning parlors. Some brand names for this product are Orobronze, Darker Tan, BronzGlo, and Carotinoid-N. The dose of canthaxanthin that this patient took was not known. A diagnosis of aplastic anemia is usually made by excluding other diagnoses when symptoms occur after the ingestion of chemicals or drugs; hence, it is possible that canthaxanthin produces toxic effects more often than is recognized. Further research regarding the potentially dangerous side effects of this compound should be carried out. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Complications and side effects, Aplastic anemia, Canthaxanthin, Orobronze (Cosmetic), Darker Tan (Cosmetic), BronzGlo (Cosmetic), Carotinoid-N (Cosmetic)

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Clinical Loyalties and the Social Purposes of Medicine

Article Abstract:

A physician discusses potential solutions to the conflict most doctors face between loyalty to individual patients and pressure to consider populations as a whole. In addition, third party insurers force doctors to focus on cutting costs. These conflicts will probably never be resolved, but they can be managed on an individual basis. In this way, doctors can maintain an effective physician-patient relationship while serving the broader goals of medicine.

Analysis, Medical ethics, Conflict (Psychology), Psychological conflict

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